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Concrete Problems: Experts Caution on Construction of Digital Health Superhighway

By MICHAEL MILLENSON

If you’re used to health tech meetings filled with go-go entrepreneurs and the investors who love them, a conference of academic technology experts can be jarring.

Speakers repeatedly pointed to portions of the digital health superhighway that sorely need more concrete – in this case, concrete knowledge. One researcher even used the word “humility.”

The gathering was the annual symposium of the American Medical Informatics Association (AMIA). AMIA’s founders were pioneers. Witness the physician featured in a Wall Street Journal story detailing his use of “advanced machines [in] helping diagnose illness” – way back in 1959.

That history should provide a sobering perspective on the distinction between inevitable and imminent (a difference at least as important to investors as intellectuals), even on hot-button topics such as new data uses involving the electronic health record (EHR). 

I’ve been one of the optimists. Earlier this year, my colleague Adrian Gropper and I wrote about pending federal regulations requiring providers to give patients access to their medical record in a format usable by mobile apps. This, we said, could “decisively disrupt medicine’s clinical and economic power structure.”

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Health in 2 Point 00 Episode 89 | IPOs, Oscar and Fitbit

Today on Health in 2 Point 00, it’s IPO day! On Episode 89, Jess asks me about the recent IPOs, Oscar Health getting into Medicare Advantage, and Fitbit accuracy in people of color. Jess asks me to weigh in on whether Livongo’s IPO was better than we expected and it’s safe to say that they are growing fast. On the flip side, the “silent” IPO that no one seems to be talking about is Health Catalyst, which is also doing quite well with a $1.6 billion valuation although they are not growing as fast as Livongo is. Next, Oscar Health decided to enter into Medicare Advantage, which is not surprising because that’s where the real money is in the insurance side. Finally, Fitbits and other wearables may not be tracking heart rates accurately in people of color, so what does this mean for the wearables industry—and their potential use for medical purposes? —Matthew Holt

Who Owns Your FitBit Data? Biometric Data Privacy Problems

The following blog post is adapted from a talk the author gave at the “Data Privacy in the Digital Age” symposium on October 26th sponsored by the U.S. Department of Health and Human Services.

Today, I’ll be focusing on the data privacy issues posed by sports wearables, which I define to include both elite systems such as WHOOP or Catapult and more consumer-oriented products such as Fitbits, and why the U.S. needs an integrated federal regulatory framework to address the privacy challenges posed by private entities commercializing biometric data.

Sports wearables have evolved from mere pedometers to devices that monitor heart rate and sleep, tell athletes how to maximize recovery, and even track food intake and sexual activity – all uploaded to the cloud.

These technologies are now ubiquitous and have wide appeal to consumers – in fact, I’m wearing a Fitbit right now.

But these devices raise several key problems for consumers that are not yet being adequately addressed by the U.S. legal and regulatory system.

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A Fail For Activity Trackers: The I Told You So’s vs Need More Datas

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Perhaps the normally measured physician-economist Aaron Carroll best captured the reaction and sentiments of the healthcare community in response to a recent JAMA article demonstrating that subjects in a weight reduction study using activity trackers lost significantly less weight than those in the control group:

“I TOLD YOU SO!!!!!!” (Emphasis in original.)

These results were cheered for several key reasons.

First, many in healthcare are irritated by the idea of simplistic technical fixes for complex medical (and social) (and cultural) (and economic) problems–like obesity.

Second, as Carroll has pointed out, exercise is healthy for many reasons, but weight loss is probably not one of them; changing your diet seems to matter a lot more.

However, it’s important to critically evaluate research even (especially) when it seems to produce an ego-syntonic conclusion–a conclusion with which we so strongly agree.

My initial reaction to the result was that perhaps it reflects an example of the concept of “moral licensing” that Malcolm Gladwell discusses so thoughtfully on his Revisionist History podcast–i.e., when you deliberately act morally in one context, you may be more likely to act less morally in another context, having already demonstrated to yourself your moral bona fides.

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The Tao of Wearables

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The hype around wearables is deafening.  I say this from the perspective of someone who saw their application in chronic illness management 15 years ago. Of course, at that time, it was less about wearables and more about sensors in the home, but the concept was the same.

Over the years, we’ve seen growing signs that wearables were going to be all the rage. In 2005, we adopted the moniker ‘Connected Health’ and the slogan, “Bring health care into the day-to-day lives of our patients,” shortly thereafter.  About 18 months ago, we launched Wellocracy, in an effort to educate consumers about the power of self-tracking as a tool for health improvement.  All of this attention to wearables warms my heart.  In fact, Fitbit (the Kleenex of the industry) is rumored to be going public in the near future.

So when the headline, “Here’s Proof that Pricey Fitness Wearables Really Aren’t Worth It,” came through on the Huffington Post this week, I had to click through and see what was going on.  Low and behold this catchy headline was referring to a study by some friends (and very esteemed colleagues) from the University of Pennsylvania, Mitesh Patel and Kevin Volpp.

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Interview with Adam Pellegrini Walgreens, VP of Digital Health

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In less than one week, the Health 2.0 8th Annual Fall Conference will feature over 200 LIVE demos, 150 speakers, on over 60 panels and sessions focused on innovative solutions within health care technology.  Indu Subaiya, CEO & Co-Founder of Health 2.0 interviewed Adam Pellegrini, VP of Digital Health of Walgreens ahead of his appearance at the 8th Annual Health 2.0 Fall Conference. Adam will be participating in the Monday main stage panel “Consumer Tech and Wearables: Powering Healthy Lifestyles.” In this interview, Adam gives insight into Walgreens innovative API creating the seamless user experience.

Indu Subaiya: So you are leading up a number of very exciting initiatives at Walgreens in terms of digital health. Let’s begin by talking a bit about the API program and the developer ecosystem that you’ve built.

Adam Pellegrini: Absolutely. So Walgreens has been offering a very robust API program for quite some time – this idea that our stores in the online space should be really an omni-channel user experience.  If you think about our stores, our stores actually have a lot of partners that actually have products in the stores.

So really, our API program is really about partners. It’s about bringing and facilitating the digital ecosystem together via API.  So for us in the Health API space, it’s about how do we help all of these different apps leverage the ingredient technologies that Walgreens has created to create a seamless friction as user experience.

IS: You mentioned that the Health API has drawn a lot of members within the Health 2.0 community.  Can you tell us a little bit about some partners there and how this is then connected to your Balance Rewards program?

AP: GenieMD is actually one of our partner apps that leverage our Refill by Scan, our personal health app that goes on both Androids and iPhones.  And some of that could be really convenient and add a value to their app by embedding the API that we have for refilling prescriptions, the Refill by Scan.

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The State of Self-Tracking

In January we started asking ourselves, “How many people self-track?”  It was an interesting question that stemmed from our discussion with Susannah Fox about the recent Pew report on Tracking for Health. Here’s a quick recap of the discussion so far.

The astute Brian Dolan of MobiHealthNews suggested that the Pew data on self-tracking for health seems to show constant – not growing – participation. According to Pew, in 2012 only 11% of adults track their health using mobile apps, up from 9% in 2011.

All this in the context of a massive increase in smartphone use. Pew data shows smartphone ownership rising 20% just in the last year, and this shows no signs of slowing down. Those smartphones are not just super-connected tweeting machines. They pack a variety of powerful sensors and technologies that can be used for self-tracking apps. We notice a lot of people using these, but our sample is skewed toward techies and scientists.

What is really going on in the bigger world? How many people are actually tracking?

A few weeks ago ABI, a market research firm, released a report on Wearable Computing Devices. According to the report there will be an estimated 485 million wearable computing devices shipped by 2018. Josh Flood, the analyst behind this report indicated that they estimated that 61% of all devices in wearable market are fitness or activity trackers. “Sports and fitness will continue to be the largest in shipments,” he mentioned “but we’ll start to see growth in other areas such as watches, cameras, and glasses.”

One just needs to venture into their local electronics retailer to see that self-tracking devices are becoming more widespread.

So why are our observations out of synch with the Pew numbers?

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Body 2.0 Health Tech Expo San Francisco

Get healthier at this year’s first ever Body 2.0 health tech expo on Sunday, October 7 in San Francisco.

Health 2.0’s first ever public event will showcase the companies at the forefront of innovation in consumer health. From biometric sensors monitoring everything from your heart rate, to the miles you’ve walked and the hours you’ve slept, technology and health have never interfaced at this level before.

Body 2.0 is for those curious about getting healthier and those already fanatical about health. Regardless of where you fall on the spectrum you will learn something new.

Try out the latest tech from companies like Azumio, ChickRx, Lark, LumoBack, Explorence, and SoloHealth.

Leaders in the field will guide you on creating a fitter, stronger and more sustainable life. Keynotes include  Dr. Arlene Blum, who was the first female to climb Mt Everest and is now the head of the Green Science Policy Institute, and Linda Fogg-Phillips, the leader of the Mobile Health Family. Also, hear from the innovators themselves like Amar Kendale from MC10, and Keith D’Amelio from Nike SPARQ.

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